Chronic diseases and health promotion

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Part Two. The urgent need for action

Chapter One. Chronic diseases: causes and health impact

The health impact of the main risk factors

The contribution of risk factors to death and disease is estimated by calculating the current "attributable" mortality and burden of disease (DALYs) caused by past exposure to the main risk factors over and above the minimum possible risk factor exposure. Chronic disease risk factors are a leading cause of the death and disease burden in all countries, regardless of their economic development status. The leading risk factor globally is raised blood pressure, followed by tobacco use, raised total cholesterol, and low fruit and vegetable consumption. The major risk factors together account for around 80% of deaths from heart disease and stroke (5). Each year at least:

4.9 million people die as a result of tobacco use;

1.9 million people die as a result of physical inactivity;

2.7 million people die as a result of low fruit and vegetable consumption;

2.6 million people die as a result of being overweight or obese;

7.1 million people die as a result of raised blood pressure;

4.4 million people die as a result of raised total cholesterol levels (5).

Further analyses using 2002 death estimates show that among the nine selected countries, the proportion of deaths from all causes of disease attributable to raised systolic blood pressure (greater than 115 mm Hg) is highest in the Russian Federation with similar patterns in men and women, representing more than 5 million years of life lost. A similar picture emerges when the contribution of the risk factors to the burden of disease (DALYs) is estimated.

The proportion of deaths attributed to raised body mass index (greater than 21 kg/m2) for all causes is highest in the Russian Federation, accounting for over 14% of total deaths, followed by Canada, the United Kingdom, and Brazil, where it accounts for 8-10% of total deaths. The pattern is similar for men and women and for the attributable burden of disease (DALYs). The estimates of mortality and burden of disease attributed to the main modifiable risk factors, as illustrated above, show that in all nine countries raised blood pressure and raised body mass index are of great public health significance, most of all in the Russian Federation.